September 26, 2017

By Jill Harkavy-Friedman, Ph.D.

If you or someone you know is experiencing a mental health, suicide or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.


Someone once asked me, “Doesn’t everyone who has a mental illness want to die at some point?” With a puzzled look on my face, I answered, “Life and the brain don’t work that way.”

Mental illnesses, such as depression, bipolar disorder and substance use disorders are certainly among the risk factors for suicide. But there are other biological, psychological, social and environmental factors that can increase a person’s risk for suicide. For example: a history of physical or sexual abuse, traumatic brain injury, chronic pain and chronic health conditions. Other contributors closer to the time of suicidal behavior may include stress, adverse life events and intoxication.

Suicide is never the result of one cause, rather a combination of risk factors coming together often in the context of stress and with access to lethal means. And while most people who die by suicide have a potentially diagnosable and treatable mental health condition, most people with a mental health condition do not die by suicide.

We have learned through research that people who have made suicide attempts think differently when in a suicidal state. Their pain and desperation affect their ability to make decisions. Their brain isn’t working flexibly, and they can’t generate alternate solutions. They are hurting—they truly believe they are a burden and their pain will never end.

This doesn’t mean they aren’t motivated to live and be productive. In fact, among people who have made a suicide attempt, more than 90% go on living and engaging with life. That’s why it’s okay—even necessary—to reach out for support when suicidal thoughts occur. And if someone reaches out to you for help, it’s essential to give the support a person experiencing suicidal ideation needs.

What Can We Do to Help?

We can all help prevent suicide by learning the risk factors and warning signs, and by being alert to changes in our family, friends and co-workers.

Trust your instincts if you notice differences in someone’s behavior. If they seem depressed, disinterested or irritable, tell them you’ve noticed, and let them know what raises your concern. If someone isn’t sleeping or they seem agitated, are drinking more alcohol than usual, try to connect and be persistent.

We know from research that asking someone directly if they’re thinking about suicide will not put the idea in their head. It will simply let them know that someone cares enough to have an uncomfortable conversation. It will let them know that help is available.

If someone mentions suicide to you, talks about how you “would be better off without them,” says you “won’t have to worry about them anymore” or believes they are a burden—take notice. These are red flags.

If a loved one is experiencing a suicidal crisis, the immediate steps you should take are removing access to lethal means and helping them get to mental health care. There are medications and therapies that have been proven to reduce suicidal ideation and change brain function in the area that controls decision-making and impulsivity. This helps to remove the tunnel vision of the suicidal moment. Finding the right health team can be a tough task, but there are people out there who will work with them to make sure they get back to feeling well.

Keep in mind that in suicidal moments people are often not at their kindest and won’t necessarily accept your efforts to connect. They are hurting, don’t feel well and don’t believe things will get better. Also know that supporting them with patience and encouragement can have a huge impact. Rather than running away, run toward them and try to be there. Recovery is a process and takes time. No one chooses to have a mental health condition, but everyone fares better with respect and compassion.


A pioneer in suicide research, Dr. Jill Harkavy-Friedman was the first researcher to ask high school students about suicidal ideation and behavior. As the Vice President of Research, she leads the American Foundation for Suicide Prevention’s growing research grant program, working with over 150 scientific advisors to evaluate progress in the field and chart the next areas of inquiry to yield impactful insights and strategies for suicide prevention. She has published over 100 articles, and has appeared as an expert in the Washington Post, USA Today, Newsweek, and other publications.

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NAMI HelpLine is available M-F, 10 a.m. – 10 p.m. ET. Call 800-950-6264,
text “helpline” to 62640, or chat online. In a crisis, call or text 988 (24/7).